医源性血管损伤的救治:附24例报告

The prevention and treatment of iatrogenic vascular trauma:a report of 24 cases

目的总结医源性血管损伤的防治经验。方法对3年来救治的2 4例各种医源性血管损伤的临床资料进行回顾性分析。结果2 4例中肠系膜上动脉、静脉损伤7例,门静脉损伤3例,颈动脉损伤4例,髂、股动脉损伤6例,其他为腘动脉、腋动脉、肾动脉、胃左动脉等损伤。治疗方法:血管修补6例,血管吻合5例,血管置换2例,血管结扎3例,介入下带膜支架型人工血管封堵2例,其他为取栓、溶栓、填塞等处理。2 4例中2 2例成功治愈,1例术后2 4 h大出血死亡,1例术后5 d死亡。结论医源性血管损伤只要高度重视,辨明解剖、充分准确、仔细操作是可以预防和减少的。一旦发生医源性血管损伤要查找原因,针对情况选择不同的处理方式,若缺乏有效的处理技术应及时求援或转院治疗。

Objectlve To summarize our experience in the prevention and treatment of iatrogenic vascular trauma. Methods The clinical data of 24 different types of iatrogenic vascular trauma committed from 2003 to 2006 were retrospectively analyzed. Results The 24 cases included 7 cases of superior mesenteric arteriovenous trauma, 3 cases of portal venous trauma, 4 cases of carotid arterial trauma, 6 cases of iliac and femoral arterial trauma, and each one of trauma of popliteal artery , axillary artery, renal artery, left gastric artery, respectively. Treated method： Six cases underwent vascular repair, 5 cases had vascular anastomosis, 2 cases had vascular replacement, 3 cases had vascular ligation, 2 cases had covered stent implantation under intervention, and other methods included thrombectomy, thrombolysis and packing. Among the 24 cases, 22 were cured completely, one patient died from massive hemorrhage 24 hours after operation, and the other died 5 days after operation. Conclusions Iatrogenic vascular trauma can be prevented and its incidence reduced by increased vigilance, clear identification of the anatomy, and accurate and careful operation. Once iatrogenic vascular trauma has occurred, its cause must be determined and then different treatment methods can be chosen, based on the cicumstaces. When effective treatment technique is not at hand, one should promptly seek outside support or transfer the patient to an advanced hostipal.